January 17, 2018

Say No to Medicaid Work Requirements

While the media obsesses about the coarse language of Dictator Donald Trump (DDT), the GOP has found ways to destroy the health and lives of people throughout the United States. Republicans claim that they don’t have enough money for nine million children’s health care in the CHIP program after they gave over $1 trillion to big corporations and the wealthy. A growing number of people are going uninsured after DDT’s work to ruin the Affordable Care Act (ACA).

Now they want work requirements and payment for Medicaid, a program created in 1965 to help people with limited income obtain health benefits that includes nursing home care. The only eligibility for participation was the level of income. The last few years of expanded Medicaid in some states has shown remarkable advantages to everyone–$3.4 billion of reduced unpaid bills in its first two years. Healthier people are better able to pay more taxes, and the increased treatment for substance abuse greatly reduced rates of robbery, aggravated assault, and larceny theft.

A major problem for tens of millions of people in the past week is the decision to allow states to impose a work requirement for people on Medicaid, primarily minorities. Seema Verma, the person in charge of this plan, helped design the Indiana Medicaid expansion that required recipients to make monthly payments. The basis for this decision is not to improve health—although that is the claim—but to siphon more money from the poor to the wealthy. Behind this plan are the Koch brothers, the Mercers, the Ricketts, and other multi-billionaire families, already benefiting from millions of dollars after the GOP tax plan.

These decision-makers ignore the fact that at least half of all non-disabled adults with Medicaid already work, and 80 percent of them live in households where at least one adult works. Of those who don’t work, 36 percent are ill or disabled; 30 percent are caregivers; 15 percent are students; and nine percent are retired. Of all the Medicaid recipients, only one-third are non-elderly adults and spend under twenty percent of total costs.

The new guidelines make “suggestions” for these classifications other than the “able-bodied adult” but don’t mandate them. To continue getting health care, these people, many of whom have trouble navigating the system, will be forced to get a doctor’s letter proving that they are within the requirements for exemptions. Doctors are responsible for deciding who lose their insurance in many cases because they must determine who is “medically fragile.” As for pay, those who cannot meet the monthly payments will then lose their coverage.

DDT’s administration announcement about the loss of Medicaid based on lack of “work” was preceded by the Treasury Department’s proposal to reduce federal rules requiring banks to provide mortgage financing in minority neighborhoods. Rules will be expanded to businesses and infrastructure projects that don’t serve the poor.

Ten states have already applied for waivers: Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin. Kentucky was the first to be accepted. Until Kentuckians elected a GOP governor, its Medicaid program was a shining example for the nation, and people loved it. The state’s adult uninsured rate fell from 18.8% in 2013 to 6.8% in 2015. Unfortunately, voters didn’t connect the program with “Obamacare” and rejected the Democrats in the 2014 election, much to their current disappointment. The result is this Medicaid proposal with these mandates:

Mandatory Medicaid premium assistance to purchase cost-effective employer sponsored insurance after the first year of Medicaid enrollment and employment for adults and their Medicaid and CHIP-eligible children;

Use of federal Medicaid matching funds for short-term Institution for Mental Disease (IMD) services for non-elderly adults in certain counties;

Removal of a proposed expansion of presumptive eligibility sites to county health departments and certain safety net providers.

If, like me, your eyes have glazed over at the complexity of these mandates, you will understand that the waiver’s goal is to greatly decrease the number of people on Medicaid and manage their personal behavior, not to make their health better. The huge cost of administering such convoluted regulations puts the money into administration instead of helping people with no money for the government to help pay for program administration.

Kentucky expects to save almost $500,000 a year with the new program, but that comes from making 95,000 people uninsured. Those are the people who will get their health care in hospital emergency rooms that will cost the state more than they save. In typical GOP doublespeak, Verma said, “We see moving people off Medicaid as a good outcome because that means they do not need the program anymore and have transitioned to a job or can afford insurance.” In the same way, the Clinton administration said changes to welfare would encourage “needy” people to find work, move out of poverty, and up the economic ladder. None of those advantages happened. TANF assistance dropped, and more people moved into poverty.

Gov. Matt Bevin said that he will drop 400,000 people off Medicaid if he doesn’t get his way to require work for the health insurance plan for the poor. Kentucky is already one of the unhealthiest states in the nation, ranking worst in cancer death rates, the second-highest smoking rate, and seventh highest obesity rate. Eight of the 13 counties in the U.S. with the largest declines in life expectancy are in Kentucky.

People who support the waivers staunchly declaim that only “able-bodied” people will be affected. Yet the exception in the new rules apply only to those who have gone through the rigorous and restrictive process of obtaining Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI). Their definition of disability:

“The inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.”

Seriously disabled people who fail this stringent definition are considered healthy and able to work, according to Republicans. Left out of the disabled definition are people with cancer, substance abuse, mental health disabilities, and other health issues. Last year, 10,000 people died while they waited for their appeals to be processed. The waivers would stop any Medicaid help for wheelchairs and other medical equipment, caregivers, and—of course—“non-emergency medical transportation.”

White people will benefit from the waivers because states can provide exemptions from work requirements in areas of high unemployment. Thee areas tend to be rural, more likely populated with white people, because they have fewer job opportunities, less reliable transportation, and fewer social services. Black people living in cities will be more burdened in the waivers.

Moms Rising listed more serious problems in a work requirement for Medicaid, a program that composed of 62 percent female and one-third children:

“This misguided policy punishes the most vulnerable members of our society and has the potential to cause millions of people to lose their health coverage just when they need support the most. It will perpetuate poverty and inequality, jeopardize the health of families, disproportionately harm women, undermine our economy, and do little to help anyone find or keep a job.

“[Work requirements] push people to accept low-paying, short-term jobs that provide no long-term stability, and they punish seasonal and hourly workers who may lose health coverage if their hours change suddenly….

“Ultimately, the only outcome of implementing work requirements will be that tens of thousands of low-income people will lose access to health care, making it that much harder for them to find jobs. Not to mention that this is just the first of many anticipated cuts to Medicaid and other essential programs that Republicans in Congress and the White House will put forward to pay for their outrageous tax law….”

As with most DDT dictates, the waivers will face court cases because the goal of the Medicaid program is to encourage work. The argument that “work promotes health” is as twisted as the German statement “Arbeit macht frei” (“work sets you free”) above the entrances to Auschwitz and other Nazi concentration camps.